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Covid’s unseen toll in India — 38% dip in screening for TB that’s still a major health crisis

According to Global TB report 2020, India accounts for 27% of global burden of TB and 31% of mortality burden. It also accounts for 27% of global cases of multidrug-resistant TB.

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New Delhi: Screening for tuberculosis has gone down significantly since the Covid-19 pandemic hit India, figures available with the Ministry of Health and Family Welfare show. This, despite the fact that because of the similarities in the symptoms of the two diseases, guidelines had been issued last August for bidirectional screening for Covid and TB. 

According to the data, in 2020, 17.19 crore people were screened for TB, of whom 52,273 were detected with the disease. This year, until June, 4.87 crore people were screened, with 13,934 of them being detected with the disease. 

Compare this with the numbers from previous years and the drop is sharp — about 38 per cent between 2019 and 2020. In 2019, 27.73 crore people were screened and of them, 62,958 cases were detected. 

Active screening for the disease began in 2017 when three rounds of the national TB screening campaign were carried out — more than 5.5 crore people were checked, of whom, 26,781 were detected with TB. In 2018, 18.93 crore people were screened and 47,307 cases were detected.

Also read: Covid could derail India’s pledge to eliminate tuberculosis by 2025 — ICMR medical journal

A public health crisis

TB has for long been termed India’s biggest public health crisis. According to the National Strategic Plan for Tuberculosis Elimination (2017-2025), TB kills an estimated 4,80,000 Indians every year and more than 1,400 every day. 

“India also has more than a million ‘missing’ cases every year that are not notified and most remain either undiagnosed or unaccountably and inadequately diagnosed and treated in the private sector,” the document says

That is why India started an initiative of active case finding through screening vulnerable populations for TB in order to detect hidden cases. The global sustainable development goal (SDG) target is to eliminate TB by 2030 but Prime Minister Narendra Modi announced that India plans to do so five years ahead of the global target by 2025.

Officials in the Ministry of Health say that active case finding for TB suffered both because of lockdown, when it was not possible for health workers to visit people, and also afterwards, because of diversion of the available health workforce for Covid-19.

ThePrint reached the health ministry through email and WhatsApp for an official response but did not receive one until the time of publishing this report.

In a press statement last month, the Press Information Bureau, the communication arm of the Government of India, said: “Due to the impact of Covid-19 related restrictions, case notifications for TB had decreased by about 25 per cent in 2020 but special efforts are being made to mitigate this impact through intensified case finding in OPD settings as well as through active case finding campaigns in the community by all states.

“Moreover, there is not enough evidence currently to suggest that there has been an increase in TB cases due to COVID-19 or due to increased case finding efforts.”

“The dual morbidity of Tuberculosis (TB) and Covid-19 can be further highlighted through the facts that both the diseases are known to be infectious and primarily attack the lungs, presenting similar symptoms of cough, fever, and difficulty in breathing, although TB has a longer incubation period and a slower onset of disease,” it added.

Also read: TB kills as many people as Covid. Let’s find a better vaccine

Bidirectional TB-Covid screening

Last August, the Government of India issued directions that all newly diagnosed TB patients or those currently on treatment should be tested for Covid-19 before they are started on the appropriate treatment. 

Similarly, all Covid-19 cases were to be screened for TB symptoms using the four-symptom complex (cough and/or persistent fever for more than 2 weeks, significant weight loss, night sweats), history of contact with a TB case, and history of TB. The guidance also said that symptomatic people should be subjected to a chest X-ray and TB testing through TrueNat or CBNAAT.

According to the Global TB report 2020, India accounts for 27 per cent of the global burden of TB and 31 per cent of the mortality burden. It also accounts for 27 per cent of the global cases of multidrug-resistant TB. In 2019, 24.04 lakh TB cases were notified. 

The number came down to 18.05 lakh cases in 2020 and 9.65 lakh cases until June 2021. It is legally mandatory for all TB cases in the country to be notified to the appropriate health authorities.

(Edited by Arun Prashanth)

Also read: US announces $57 million aid for TB treatment in 7 high-burden countries including India



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